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Old 11.12.2012, 09:54
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US versus Swiss health insurance

This post is made purely in the spirit of enquiry, given I don't live either in the US or Switzerland.

But I'm curious. Recently obviously US healthcare has been incredibly controversial. How is Obamacare different though from the Swiss system?

Would you recommend the Swiss healthcare system?
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Old 11.12.2012, 11:16
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Re: US versus Swiss health insurance

I will leave it to someone else to fill in the details, but the biggest difference between the two is that it is not compulsory in the US to purchase health insurance. If you choose not to, under Obamacare, you are fined. In Switzerland it is simply compulsory. The Swiss system would most likely be considered unconstitutional in the US, despite the fact that it is market-oriented.

First and foremost, the controversy of Obamacare stemmed from whether it would set a precedent that the Government could compel a citizen to purchase a good or service. Secondly, the concern was that it would pave the way for a single-payer system run by the Federal Government.

In Switzerland, where Government does a better job of working for the people, you have a mandate, but no State run health care. The private insurance market is very healthy here, however the basic mandated health insurance cannot be profitable for insurers. In my opinion it has a far superior system to the US in practice. In theory, only in fairly homogenous cultures could the government get away with compelling people to purchase a good or service. It wouldn't fly in the US, so we will lose out on the practical advantages.

Last edited by acd483; 11.12.2012 at 11:27.
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Old 11.12.2012, 11:30
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Re: US versus Swiss health insurance

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In Switzerland it is simply compulsory. The Swiss system would most likely be considered unconstitutional in the US.
Tricky. The Swiss system is part of the Swiss constitution (Art. 117), that would mean if the Swiss system was used in the U.S. it must be part of the U.S. constitution too. Thus no longer unconstitutional.
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Old 11.12.2012, 11:40
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Re: US versus Swiss health insurance

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Tricky. The Swiss system is part of the Swiss constitution (Art. 117), that would mean if the Swiss system was used in the U.S. it must be part of the U.S. constitution too. Thus no longer unconstitutional.
Great point. The biggest difference is that the Swiss system is part of their constitution. Obamacare is simply a bill that has been declared constitutional as a fine.

More importantly, there's zero chance the constitution will be amended to allow the U.S. Government to compel a citizen to buy a good or service. At least at the moment...
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Old 11.12.2012, 12:49
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Re: US versus Swiss health insurance

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This post is made purely in the spirit of enquiry, given I don't live either in the US or Switzerland.

But I'm curious. Recently obviously US healthcare has been incredibly controversial. How is Obamacare different though from the Swiss system?

Would you recommend the Swiss healthcare system?
This is a very complicated question.

First, you need to realize that the total population of Switzerland is about 7.5 million compared to over 300 million in the U.S., and there are many things that can work in a small country that do not scale up that much.

When Obamacare was being proposed and before Congress, I read occasional articles in the US press pointing out the Swiss model as preferable. I felt those articles were incredibly simplistic, not mentioning basic realities like the fact that a significant portion of the Swiss population (20 - 30%, I think??) has the cost of their health insurance subsidized because they cannot afford it.

Having made the move from the US and a great health insurance package through my husband's job, to shopping for health insurance here, it is very clear to me that we personally have much higher out of pocket costs for health care and insurance while living in Switzerland. One reason for that is that health insurance is a standard part of employee benefit packages in the US, though not everyone employed in the US obviously gets that type of package. Our share of the cost for an excellent health insurance policy for a family of four with a total family "franchise" (called a deductible in the US) of $600/year was about $500/month. Here we pay closer to 1500 CHF/month for 3 of us for health insurance with comparable coverage. The only benefit I know of that is beyond what we got in the US is partial coverage of our gym memberships. Note that I do not know how much my husband's employer contributed to our health insurance. To further confuse the situation, in Switzerland, employee packages are more likely to cover a car and what my husband gets for that means we come out about even.

Another factor that is frequently not mentioned in the discussions is that the health insurance companies have a lot of restrictions on what they offer for basic coverage and how they charge for it. My understanding is that over time, companies have been getting out of the health insurance market and that the number of companies in the business is shrinking. Costs to consumers also go up every year. My impression is that the Swiss health insurance system is not particularly healthy and stable, though maybe the predictions I've heard are overly pessimistic.

Anyway, I would recommend the Swiss health insurance system for Switzerland, but I do not believe the model could be exported to any other country in its current form.

Oops, just realized the OP was asking about the healthcare system and not the health insurance system. Sorry, but which aspects of the healthcare system are you referring to?

Last edited by LearningAlways; 11.12.2012 at 12:59. Reason: Wasn't finished - accidentally posted it! ;-P
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Old 11.12.2012, 14:34
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Re: US versus Swiss health insurance

I've lived in both countries. I have the impression that the Swiss system is better. With the basic required coverage, you know you are covered for almost any health problems (except dental). I pay about Fr. 310.- month but i think this depends on age. In the US you better read the fine print on your particular policy. If you have a health problem, you could be bankrupted. In Switzerland you get excellent care no matter what your social class is. In the US if you are very wealthy you can get good care. If not in the US it is 3rd world care. Also in the US you have to factor in the costs of lawsuits and the huge number of people showing up in emergency rooms with no health care insurance at all.
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Old 11.12.2012, 14:42
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Re: US versus Swiss health insurance

The Swiss system was much better before they made it mandatory back in the mid '90s, since then prices have been going up and up.

Tom
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Old 11.12.2012, 14:48
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Re: US versus Swiss health insurance

I think it's easy for mandatory health insurance to work well in a country like CH, which has very little poverty, relatively high salaries, etc. But in a country like the U.S., in which an increasing number of people are losing their homes, can't afford to feed their children, awful job market, etc., I think it would be cruel to require people to pay for "what ifs."

What I think the U.S. government needs to do is to stop focusing all of its financial resources abroad (military) and, instead, to start taking better care of its own people. I also think that more U.S. companies should offer health benefits to its employees.
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Old 11.12.2012, 14:55
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Re: US versus Swiss health insurance

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Note that I do not know how much my husband's employer contributed to our health insurance.
If you were paying 500 the company was probably paying 1,000 so 1,500 total. Thats about the cost for family coverage. It would have been known through HR what the split was 70/30 60/40 is "standard".

The price of health care in the US for the company I worked for rose 15% every year 2007 to 2010.
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Old 11.12.2012, 15:00
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The Swiss system was much better before they made it mandatory back in the mid '90s, since then prices have been going up and up.

Tom
Are talking about quality or just cost here?
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Old 11.12.2012, 15:02
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Re: US versus Swiss health insurance

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Are talking about quality or just cost here?
Costs, quality is the same.

Tom
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Old 11.12.2012, 15:03
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Re: US versus Swiss health insurance

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I will leave it to someone else to fill in the details, but the biggest difference between the two is that it is not compulsory in the US to purchase health insurance. If you choose not to, under Obamacare, you are fined.
Not true. In MA healthcare has been compulsory for a while now....we called it Romneycare ( A Republican if you recall) . It works well and I haven't seen the four horsemen go by. http://en.wikipedia.org/wiki/Massach...th_care_reform

One difference is that the burden is carried by the employer in the US and in Switzerland it's carried by the individual. In CH, the employer paid the premium for the husband, but it was 800chf per month for the kid and myself at one of the higher deductible franchises. In the US, it's $180/mo for us all and very little out of pocket. For all that money in CH, too, they didn't even cover my daughter's annual flu shot. If you have coverage in the US, you likely will spend a lot less, particularly if you're younger, healthy and do the preventative.

Oh, and don't even ask about dental insurance in CH.....
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Old 11.12.2012, 15:11
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Re: US versus Swiss health insurance

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I think it's easy for mandatory health insurance to work well in a country like CH, which has very little poverty, relatively high salaries, etc. But in a country like the U.S., in which an increasing number of people are losing their homes, can't afford to feed their children, awful job market, etc., I think it would be cruel to require people to pay for "what ifs."

What I think the U.S. government needs to do is to stop focusing all of its financial resources abroad (military) and, instead, to start taking better care of its own people. I also think that more U.S. companies should offer health benefits to its employees.
The cost of entitlements far outweighs the cost of wars. Not that I am in favor of warring, in fact, the U.S. needs to reduce its military footprint, but wars end. Entitlements only grow in cost and now we're seeing it's impossible to pay for them over the long term. And would someone please explain to me how any form of health care/insurance is feasible once most people start living into their 90s and 100s? It used to be that (on average) people worked their whole life, had five years of retirement and then croaked at 65. With every cure and technological breakthrough, general health improves, people live longer and yet still require care. Switzerland will do the responsible thing by raising the retirement age, but the U.S. must take at least the same action and begin reforming entitlements if anyone is to expect them to function past the current generation.
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Old 11.12.2012, 15:29
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Re: US versus Swiss health insurance

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Not true. In MA healthcare has been compulsory for a while now....we called it Romneycare ( A Republican if you recall) . It works well and I haven't seen the four horsemen go by. http://en.wikipedia.org/wiki/Massach...th_care_reform

One difference is that the burden is carried by the employer in the US and in Switzerland it's carried by the individual. In CH, the employer paid the premium for the husband, but it was 800chf per month for the kid and myself at one of the higher deductible franchises. In the US, it's $180/mo for us all and very little out of pocket. For all that money in CH, too, they didn't even cover my daughter's annual flu shot. If you have coverage in the US, you likely will spend a lot less, particularly if you're younger, healthy and do the preventative.

Oh, and don't even ask about dental insurance in CH.....
Romneycare was the basis for Obamacare...both are fines on people who fail to purchase health insurance. It's not a true compulsory system and frankly, its costs are way above projections...prompting the MA legislature to force more restrictive price controls. So the government will be limiting the cost of health care to keep expenses down which will lead to rationing, long waits, lower quality, etc.

We also face a major structural problem. Millions more insured, millions more expecting increased care without any change in the number of healthcare providers. Doctors are too scarce, so guess what? Health care will be a two-tiered system. If you can pay now with private insurance, welcome in. If the doctor's office has to get reimbursed later, you go straight to the back of the line.
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Old 11.12.2012, 15:31
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To compare the US to Switzerland:

In CH, Insurance is required, rarely paid by employer (sometimes paid by employer for expats)
Risk is shared over a large group e.g age 26 to 80, women pay more than men. So between 26 and 80, same gender same post code, you pay the same for the same franchise, same model, same company.
No one is excluded for prexisting conditions for the required part.

In the US, insurance may be paid in part or full by the employer, for part or all of the family.
If you have a large enough employer and therefore, large enough risk group, pre-existing and age don't matter. If you work partime, or for a small firm many employers willnot cover you. If you work for yourself, same situation perhaps. and you may have a hard time finding someone who will insure you for reasonable cost, including your current health conditions. You may be dropped from coverage if you use too much. Huge variation in quality, programsm etc.


As an aside, something like 25% of families in the US where a family member has cancer experience financial difficulties due to expenses related to the disease.
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Old 11.12.2012, 21:37
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Re: US versus Swiss health insurance

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In the US, it's $180/mo for us all and very little out of pocket. For all that money in CH, too, they didn't even cover my daughter's annual flu shot. If you have coverage in the US, you likely will spend a lot less, particularly if you're younger, healthy and do the preventative.
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To compare the US to Switzerland:

In CH, Insurance is required, rarely paid by employer (sometimes paid by employer for expats)

As an aside, something like 25% of families in the US where a family member has cancer experience financial difficulties due to expenses related to the disease.
$180 per month is a great deal but I would consider that not normal. I assume your husband`s company is paying something like 90%/10% split or 80%/20%.

We have the opposite paid $600-$800 per month in the US (using my wife`s insurance but it would be the same on my company) and healthcare is fully provided by the wife`s company here at about 900chf per month (it is a taxable fringe benefit and is on pay slip). She is not on an expat contract but works in the Pharma sector.

I think on average costs are about the same or just slightly higher in Switzerland.

I have seen people really suffer in the US when someone is seriously ill even though "well covered". One woman had to sell her house to fund operations on her child and was left broke. My boss who was an executive was stretched to the limits on co pays when they had complications with their baby. I don`t know if that would happen here.
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Old 12.12.2012, 00:53
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Re: US versus Swiss health insurance

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$180 per month is a great deal but I would consider that not normal. I assume your husband`s company is paying something like 90%/10% split or 80%/20%.

We have the opposite paid $600-$800 per month in the US (using my wife`s insurance but it would be the same on my company) and healthcare is fully provided by the wife`s company here at about 900chf per month (it is a taxable fringe benefit and is on pay slip). She is not on an expat contract but works in the Pharma sector.

I think on average costs are about the same or just slightly higher in Switzerland.

I have seen people really suffer in the US when someone is seriously ill even though "well covered". One woman had to sell her house to fund operations on her child and was left broke. My boss who was an executive was stretched to the limits on co pays when they had complications with their baby. I don`t know if that would happen here.
It wouldn't happen in Switzerland, not by a long shot. Health care is obligatory in Switzerland and no one can be denied health care. Regardless of any pre-existing conditions. The Swiss checks a person's/family taxes each year. If they see that your health insurance premiums are too high for the money you make,they will automatically subsidize your health care. In US with the new health care plan, if you can't pay, they want to fine you!
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Old 12.12.2012, 02:10
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Re: US versus Swiss health insurance

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It wouldn't happen in Switzerland, not by a long shot. Health care is obligatory in Switzerland and no one can be denied health care. Regardless of any pre-existing conditions. The Swiss checks a person's/family taxes each year. If they see that your health insurance premiums are too high for the money you make,they will automatically subsidize your health care. In US with the new health care plan, if you can't pay, they want to fine you!
You sure about that? I wasn't pregnant when we arrived, but I recall another spouse who was and, apparently, you have to be paying into the plan for a year prior to have the insurance cover it and so it would be largely out of pocket whatever the basic didn't cover. It sounded a bit scary as complications would also not be covered as I recall. Insurance companies are the same the world over and Switzerland is no different. The happily take your money and make it a lot less easy to get it back.
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Old 12.12.2012, 03:12
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Re: US versus Swiss health insurance

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but it was 800chf per month for the kid and myself at one of the higher deductible franchises. In the US, it's $180/mo for us all and very little out of pocket.
Hard to compare, $180 US/month is a lot of money for someone living in a state like Mississippi or West Virginia where wages are a mere fraction of someone doing the same job in CH.
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Old 12.12.2012, 07:40
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Re: US versus Swiss health insurance

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You sure about that? I wasn't pregnant when we arrived, but I recall another spouse who was and, apparently, you have to be paying into the plan for a year prior to have the insurance cover it and so it would be largely out of pocket whatever the basic didn't cover. It sounded a bit scary as complications would also not be covered as I recall. Insurance companies are the same the world over and Switzerland is no different. The happily take your money and make it a lot less easy to get it back.
Are you sure about that? I was pregnant when I arrived, and I was covered immediately and all the costs were paid.
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